Surgical Strategies for Distal Anterior Cerebral Artery Aneurysms

INTRODUCTION: Distal anterior cerebral artery (DACA) aneurysms are rare and possess different features in terms of surgical treatment and follow-up. We present our clinical experience about DACA aneurysms in this manuscript.
METHODS: Retrospective analysis of 411 patients who were operated in our clinic for intracranial aneurysm between April 2015 and May 2019 was presented. These patients were evaluated in terms of age, sex, clinical and radiological features, grade of the aneurysm according to the World Federation of Neurological Surgeons, surgical strategies, prognostic factors affecting surgical results, and patient discharge scores named as modified Rankin scores (mRSs).
RESULTS: In our study, 21 DACA aneurysms were detected and gender distribution was observed in the form of 10 male and 10 female patients. Twenty had saccular aneurysm and one had infundibular aneurysm. Eleven of 20 patients had multiple aneurysms and 17 had subarachnoid hemorrhage. It was detected incidentally in three patients. When patients were evaluated according to the aneurysm diameter, 19 had aneurysms of 3–7 mm in diameter and two had aneurysms of 8 mm in diameter. Frontotemporal approach was performed for 11 patients with multiple aneurysms, whereas interhemispheric approach was used for nine patients with isolated DACA aneurysms. mRS was 0 for 15 patients, 1 for two patients, 5 for two patients, and 6 for one patient (exitus).
DISCUSSION AND CONCLUSION: Although DACA aneurysms are small in size, they should be treated surgically or endovascularly. Coexistence with multiple aneurysms is frequent. Elder age and coexistence with multiple aneurysms are poor prognostic factors.